The Endoscopy Triage Nurse As A Valuable Gatekeeper To GI Endoscopy
C Mc Closkey, E Slattery
Gastroenterology Department, University Hospital Galway, Newcastle Road, Co. Galway
Endoscopic procedures are a costly and limited resource. Inappropriate referrals are frequent despite well-defined guidelines, and add significantly to the burden of endoscopy waiting time. Recent data suggests the utilisation of an endoscopy triage nurse can effectively mitigate this burden, and ensure urgent procedures are more effectively prioritised by data collection and clarification along with brief clinical interview if required.
To evaluate the outcomes of referrals to the UHG endoscopy service since the introduction of a triage nurse in 2022. Access to waiting lists has been streamlined with appropriate vetting now standard.
Data was obtained from a prospectively maintained database that contained details of all referrals, patient data, and outcomes. This data covered an 8-month period from January to August 2022.
There were 1915 referrals over an 8-month period, approximately 240 per month. The referral was deemed appropriate and unchanged in just 34% of cases. After triage, 20% were referred to gastroenterology OPD for further assessment, with 10% referred back to GP or surgeons. In total; 68% of OGD requests, 55% of colonoscopy requests and 70% of combined procedure requests were performed. Overall 37% less procedures were performed than requested. Just 44% of urgent referrals were validated as truly urgent, and requests were downgraded to routine or alternative investigations when appropriate (e.g. flexible sigmoidoscopy, CT etc.). Cases were discussed with a GI consultant before a decision was made. When compared to pre-pandemic levels of referral for endoscopy in 2019 compared to post pandemic in 2022; we saw an average reduction of 27.3% of referrals per month being added to the endoscopy wait list despite an apparent increased volume of referrals to the unit post-COVID due to the additional work of the endoscopy triage nurse.
The endoscopy triage nurse is a cost effective and critical component in the delivery of endoscopy in over-burdened health systems. They provide rapid and urgent endoscopy when required and prevent the unnecessary use in other patients where alternative strategies may be more appropriate thereby ensuring those who need it most; get it.